Understanding the ways in which human factors, such as non-technical skills, influence individual and team performance can ultimately improve patient safety, particularly in high-intensity settings such as operating rooms.

In 2019, Cambridge University Hospitals launched the Observation of Non-technical Skills and Teamwork (ONSeT) program, which focused on observation and feedback to evaluate the impact of human factors education in operating rooms. Human Factors Champions (nurses and clinical leads who received human factors training) observed teams working in the operating room and applied two validated observation tools (the Scrubs Practitioners List of Intra-Operative Non-Technical Skills [SPLINTS] and the Mayo High Performance Teamwork Scale) to score observed behavior and provide structured feedback to teams to ultimately improve efficiency and safety in the operating room.

At the start of the COVID-19 pandemic, all non-cancer elective surgery was put on hold and the ONSeT program was paused. When surgical work resumed in September 2020, researchers surveyed Human Factors Champions about their perceptions of whether prior experience with the ONSeT program helped operating room teams during the pandemic. The majority of respondents felt better able to perform as team leads, supervise their teams, provide accurate and timely feedback, articulate challenges and barriers, and ensure a shared mental model of the importance of human factors in individual and team performance.

Related Resources

Mitchell L, Flin R, Yule S, Mitchell J, Coutts K, Youngson G. Evaluation of the Scrub Practitioners' List of Intraoperative Non-Technical Skills system. Int J Nurs Stud. 2012;49(2):201-211. [Available at]

Malec JF, Torsher LC, Dunn WF, et al. The mayo high performance teamwork scale: reliability and validity for evaluating key crew resource management skills. Simul Healthc. 2007;2(1):4-10. [Available at]

Related Report

Chartered Institute of Ergonomics & Human Factors. Human Factors in Health Care. London, UK: Health Education England; 2019. Accessed September 20, 2021 [PDF]